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Published on: June 30, 2023
Using Lean to Enhance Heart Failure Patient Identification Processes and Increase Core Measure Scores
Jennifer R Hunt1, Kelli Jo Ouellette, Michelle Reece
1Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City (Ms Hunt); Intensive Care Unit, Johnson City Medical Center, Johnson City, Tennessee (Ms Ouellette); and Department of Public Health, College of Health and Human Services, Western Kentucky University, Bowling Green (Dr Reece).
Insights
Implementing an interdisciplinary process improvement initiative significantly reduced heart failure (HF) readmissions and improved HF core measure (CM) compliance, achieving 100% compliance.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
- Health Systems Management
Background:
- Heart failure (HF) is a primary cause of hospitalization for older adults in the US.
- Health systems aim to reduce HF readmission rates for quality and cost benefits.
- Low Heart Failure Core Measure (CM) scores at the medical center indicated a need for process improvement.
Purpose of the Study:
- To identify barriers to improving Heart Failure Core Measure (CM) scores.
- To implement a system for accurate HF patient documentation and CM compliance.
- To enhance patient follow-up care post-discharge.
Main Methods:
- An interdisciplinary team analyzed existing processes and identified documentation gaps.
- Implemented an accurate reporting system with error-proofing measures.
- Redesigned patient identification and established pre-discharge follow-up appointments in the EMR.
Main Results:
- 30-day readmission rates decreased from 12% to 8%.
- Heart failure Core Measure (CM) compliance increased from 88% to 100%.
- Identified HF patients during hospitalization rose from 83% to 100%, and 7-day follow-up appointments increased to 98%.
Conclusions:
- Interdisciplinary collaboration and lean methodologies successfully improved HF metrics.
- Process redesign led to significant enhancements in patient care and compliance.
- Achieved target metrics and improved overall quality of care for heart failure patients.
Background:
Heart failure (HF) is the leading cause of hospitalization among older adults in the United States. Health systems target readmission rates for quality improvement and cost reduction.
Local Problem:
Heart failure core measure (CM) scores at our medical center were lower than the national average, and methods for capturing the appropriate documentation on HF patients to ensure CM compliance were not clear.
Methods:
An interdisciplinary team determined barriers to increasing CM scores, gathered baseline data, and identified gaps in the existing process.
Interventions:
The team implemented an accurate reporting system and error-proofing process, redesigned the process for identifying patients admitted with a HF diagnosis, and developed a patient appointment section before discharge in the electronic medical record.
Results:
There was a decrease in readmissions within 30 days of implementation from 12% to 8%, and HF CM compliance score increased from 88% to 100%. The percentage of HF patients not identified during hospitalization decreased from 17% to 0%. Heart failure patients discharged with a 7-day follow-up appointment increased from 88% to 98%.
Conclusion:
Through implementation of an interdisciplinary-led process improvement and lean methodologies, metrics and CMs were achieved.
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